Abstract
Hemicraniectomy (HC) improves mortality in Malignant Middle cerebral artery Infarctions (MMI), but patient selection and optimal timing for HC remains unclear. A continuous method to monitor for the risk and development of herniation from infarction would allow a better selection of patients for HC We hypothesized that certain EEG features reflective of worsening mass effect will be easier to detect on quantitative EEG (qEEG) analysis trends We studied qEEG trends before, during clinical deterioration (drop in GCS by at least 3 points) and after administration of osmotherapy. qEEG trends included rhythmicity spectra 0-25 Hz (scale 0- 2uV/Hz), Color Density Power Spectra (CSA) 0-20Hz (scale 0-2uV/Hz), amplitude integrated EEG (aEEG): 0-100uV and VsRhythmicity spectrogram 1 - 25 Hz (-3-3 Zscore) Trends demonstrated bilateral loss of power on beta and alpha frequencies and increase in theta preceded clinical deterioration by approximately 1 hour (left > right). Patient2 subsequently had a robust theta power increase (+z score, red) in left > right hemisphere which coincide with clinical deterioration on vsRhythmmicity Spectrogram. Also, there was a decreased of fast and slow frequencies bands on rhythmicity spectrogram and CSA with a diffuse attenuation outlined by aEEG (Left > right). Following osmotherapy gradual improvement in all frequencies is seen but with an incomplete recovery in patient1 with lower alpha and theta power on right posterior and anterior quadrants suggested ongoing uncal and sub-falcine herniation, later confirmed on imaging Changes on qEEG reflecting impaired perfusion during acute herniation can manifest as decreased power in all frequency bands of varying severity prior to clinical deterioration. These changes can be completely or partially reversed with osmotherapy. Partial EEG response to osmotherapy may represent a potential sign of patients who will fail medical management and need DC. qEEG may be a helpful tool in HC patient selection
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